Providing a Continuum of Perinatal Services, Assessment Process involves


Providing a Continuum of Perinatal Services

Pregnant women should have access to readily available and regularly scheduled obstetric care, within their communities. The services include:

  • Access to Out-Reach Programs - Outreach programs for women should target teens and low-income women. Outreach programs which make contact with the family of every newborn should be coordinated to ensure that no infant is missed and that services are unduplicated.
  • Access to outpatient/ambulatory services is essential to improving maternal and infant health. Women of child-bearing age should have access to preconception care including:
    • Timely availability of family planning services
    • Early verification of pregnancy and basic pregnancy care
    • Risk assessment and medical specialty referrals when necessary
    • Parenting education or referrals for parenting education
    • Referrals for bereavement counseling in cases of spontaneous abortion (miscarriage), fetal death (stillbirth) or infant death
    • Referrals for social problems, e.g., domestic violence
    • Family Case management and follow-up
  • Access to in-patient services should be available in spite of medical and/or social problems such as financial barriers, lack of transportation or inability to speak English.
  • Access to Neonatal and Infant services Every neonate/infant should have services capable of providing:
    • Well-child and preventive care, e.g., immunizations
    • Acute problem care
    • Medical specialty referrals when necessary
    • Referrals for early intervention (e.g., newborn hearing screening, vision screening, speech therapy, physical therapy) to prevent developmental delays
    • Case management and follow-up
    • Clinical Management during the First, Second, and Third trimesters
  • First Trimester (Return visits)
  • Patient Education include the following:
    • Explanation of care/prenatal visits
    • Nutritional requirements of pregnancy
    • Nausea and vomiting during first trimester
    • Weight gain during first trimester
    • Fetal growth
    • Drug use during first trimester / risk to pregnancy
    • Quickening
    • Maternal blood pressure
    • Danger signs in pregnancy
    • First trimester bleeding / Danger signs
    • Resources for emergency care
    • Genetic counseling
    • Physical exercise in pregnancy / limits
    • Working while pregnant / Hazards to pregnancy
    • Maternal seatbelt use
    • Exposure to environmental toxic substances / risks to pregnancy
    • Oral hygiene / dental care during pregnancy.
    • Financial plan
  • Second Trimester (Repeat Visits)
  • Maternal vital signs
  • Ongoing physical assessment
  • Ongoing nutritional assessment/counseling
  • Maternal weight gain
  • Sexual activity during pregnancy
  • Partner involvement
  • Physical activity during pregnancy / limits
  • Enrollment in prepared childbirth classes
  • Fetal development
  • Fetal growth
  • Fetal heart rate
  • Preparing breasts for Breast-feeding /Breast feeding promotion and education
  • Maternal seatbelt use
  • Pre-term labor symptom recognition
  • Third Trimester (Repeat Visits) Assessment during the third trimester will include the
  • Maternal vital signs
  • Preparation for labor/birth
  • Fetal heart rate monitoring
  • Fetal movement counting
  • Work/activity counseling
  • Introduction to Infant car seat use
  • Infant care and feeding, including breast-feeding support
  • Signs/symptoms of true and false labor
  • What to do when in true labor
  • Fetal monitoring
  • Preparation for parenting
  • Instructions regarding Immediate postpartum period
  • Nutritional needs
  • Wound care / abdomen / episiotomy / Vagina / personal hygiene
  • Family planning method / when to

The Assessment Process is On-going and involves the following:

  • Confirming demographic information
  • Review of gynecologic history, including the date of the last menstrual period (LMP)
  • Review Obstetric history
  • Confirming Estimated day of delivery (EDD) determined by the last menstrual period if known. If the date is unknown or a size-date discrepancy exists, an ultrasound examination should be performed before 20 weeks.
  • Review History of current pregnancy
  • Accurately dating pregnancy
  • Review Medical/surgical history
  • Genetic history review
  • Social history/Lifestyle behaviors
  • Environmental exposures
  • Pharmacologic history
  • Nutritional assessment including pregnancy weight and body mass index (BMI)
  • Psycho-social assessment
  • Physical examination
  • Financial planning